07383 (GRES)Building 51:440Address
Owner
T4ht 4 4 Q"
P.O. BOX 1504
78-105 CALLE ESTADO
LA QUINTA, CALIFORNIA 92253
R 10 Construction
Mailing _
Address ' PO Box 366
City Zip Tel.
La Quinta 92253 564-4832
Contractor
Same
Address
State Lic. 487584
& Classif.
Arch., Engr.,
Designer
Address
Lic. #
Tel.
CityI Zip I State I
Lic. #
I hereby affirm that I am
7000) of Division 3 of the I
effect.
DECLARATION
oLChapter 9 (commencing with Section
od�yand my license is in full force and
OWNEWBUILDER DECLARATION
I hereby affirm that I am exempt from the Contractor's License Law for the following
reason: (Sec. 7031.5,Bustness and Professions Code: Any city or county which requires a
permit to construct, after, improve, demolish, or repair any structure, prior to its issuance also
requires the applicant for such permit to rile a signed statement that he is licensed pursuant to
the provisions of the Contractor's License Law, Chapter 9 (commencing with Section 7000) of
Division 3 of the Business and Professions Code, or that. he is exempt therefrom, and the basis
for the alleged exemption. Any violation of Section 7031.5 by 'any applicant for a permit
subjects the applicant to a civil penalty of not more than rive hundred dollars ($500).
❑ I, as owner of the property, or my employees with wages as their sole compensation, will
do the work, and the structure is not intended or offered for sale. (Sec. 7044, Buisness and
Professions Code: The Contractor's License Law does not apply to an owner of property who
builds or unproves thereon and who does such work himself or through his own employees,
provided that'such improvements are not intended or offered for sale. n however, the building
or improvement is sold within one year of completion, the owner -budder wig have the burden
of proving that he did not build or improve for the purpose of sale.)
❑ I, as owner of the property, am exclusively contracting with licensed contractors to con-
struct
onstruct the project. (Sec. 7044, Business and Professions Code: The Contractor's License Law
does not apply to an owner of property who builds or improves thereon, and who contracts for
such projects with a contractor(s) licensed pursuant to the Contractor's License Law.)
❑ 1 am exempt under Sec. B. 8 P.C. for this reason
Date Owner +
I
{
WORKERS' COMPENSATION DECLARATION
1 hereby affirm that 1 have a certificatefof consent to self•insure, or a certificate of
Worker's Compensation Insurance, or a certified'copy thereof. (Sec.-3800'L'a6`7'Code.)
Policy No. Company &
❑ Copy is filed with the city. ❑ Certified copy is hereby fumished.
CERTIFICATE OF EXEMPTION FROM
WORKERS' COMPENSATION INSURANCE
(This section need not be completed if the permit is for one hundred dollars (5100) valuation
or less.)
I certify that in the performance of the work for which this permit is issued, I shall not
employ any person in any manner so as to become subject to the Workers' Compensation
Laws of California.
Date Owner
NOTICE TO APPLICANT: ff, after making this Cerhrrate of Exemption you should become
subject to the Workers' Compensation provisions of the Labor Code, you must forthwith
comply with such provisions or this permit shall be deemed revoked.
CONSTRUCTION LENDING AGENCY
I hereby affirm that there is a construction lending agency for the performance of the
work for which this permit is issued. (Sec. 3097, CIT Code.)
Lender's Name
Lender's Address
This is a'building permit when properly filled out, signed and validated, and is subject to
expiration it work thereunder is suspended for 160 days.
I certify that I have read this application and state that the above information is correct.
I agree to comply with all city and county ordinances and state laws relating to building
construction, and hereby authorize representatives -of this city to enter the above-.
mentioned property for inspection purposes.
Signature of applicant Date
Mailing Address
City,. State, Zip
No. 07383
BUILDING: TYPE CONST. OCC: GRP.
A.P. Number 773-052-011 ,012
Legal Description Lots 11-12 Block 44
Project Description
Sq. Ft.(',t No. No. Dw.
Size Stories Units
New ❑ Add ❑ Alter ❑ Repair ❑ -Demolition ❑
Garage 837 sq.feet
Wa l inc faded
Estimated Valuation $167,,397
PERMIT AMOUNT
25000
Plan Chk. Dep. .
Plan Chk. Bal. Q 7 u•^8-
Const.
Mech.
Electrical
Plumbing
S.M.I. . f
Grading
Driveway Enc.
Infrastructure a
TOTAL L��.$ •`d am r A
REMARKS
ZONE: BY:
Minimum Setback Distances:
Front Setback from Center Line
Rear Setback from Rear Prop. Line
Side Street Setback from Center Line
Side Setback from Property Line
FINAL DATE INSPECTOR
Issued by: Date 3/20`9fplermit
Validated by:
Validation:
CONSTRUCTION ESTIMATE
NO. ELECTRICAL FEES
NO. PLUMBING FEES
1ST FL. SQ. FT. ® $
UNITS
SLAB GRADE3
ROUGH PLUMB.
BONDING
YARD SPKLR SYSTEM
2ND FL. SQ. FT. ®
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
MOBILEHOME SVC.
BAR SINK`
POR. SQ. FT. ®
GAS (ROUGH) O
METER LOOP
HEATING (FINAL)
POWER OUTLET
ROOF DRAINS
GAR. SQ. FT. ®
TEMP. POLE
GROUT
DRAINAGE PIPING
CAR P. SQ. FT. ®
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
DRINKING FOUNTAIN.
WALL SQ. FT.
=$
LUMBER GR.
FRAMING
ROOFING O
URINAL
SQ. FT.
��_
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REMARKS:
ESTIMATED CONSTRUCTION VALUATION $
WATER PIPING
NOTE: Not to be used as property tax valuation
FLOOR DRAIN
MECHANICAL FEES
WATER SOFTENER
VENT SYSTEM FAN EVAP.COOL HOOD
SIGN
WASHER(AUTO)(DISH)
APPLIANCE DRYER
GARBAGE DISPOSAL
FURNACE UNIT WALL FLOOR SUSPENDED
LAUNDRY TRAY
AIR HANDLING UNIT CFM
KITCHEN SINK
ABSORPTION SYSTEM B,T,U,
TEMP USE PERMIT SVC
WATER CLOSET
COMPRESSOR HP
POLE, TEM/PERM
LAVATORY
HEATING SYSTEM FORCED GRAVITY
AMPERES SERV ENT
SHOWER
BOILER B.T.U.
SQ. FT. ® c
BATH TUB
SQ. FT. ® c
WATER HEATER
MAX. HEATER OUTPUT, B.T.U.
SO. FT. RESID ® 11/4 c
SEWAGE DISPOSAL
CERT. OCC.
SQ.FT.GAR ® V4c
HOUSE SEWER
FENCE FINAL
GAS PIPING
PERMIT FEE
PERMIT FEE
PERMIT FEE
DBL
TOTAL FEES
MICRO FEE
MECH.FEE PL.CK.FEE
CONST. FEE ELECT. FEE
SMI FEE PLUMB. FEE
STRUCTURE PLUMBING ELECTRICAL HEATING & AIR COND. SOLAR
SETBACK -31;.01
UMBING
UNDERGROUND
A.C. UNIT
COLL. AREA
SLAB GRADE3
ROUGH PLUMB.
BONDING
HEATING (ROUGH)
STORAGE TANK
FORMS
SEWER OR SEPTIC TANK
ROUGH WIRING.
DUCT WORK
ROCK STORAGE
FOUND. REINF.
GAS (ROUGH) O
METER LOOP
HEATING (FINAL)
OTHER APPJEQUIP.
REINF. STEEL
GAS (FINAL)
TEMP. POLE
GROUT
WATER HEATER
SERVICE
FINAL INSP.
BOND BEAM
WATER SYSTEM
FINAL INSP.
FINAL INSP.
GRADING
/ cu. yd.
$ plus x$
=$
LUMBER GR.
FRAMING
ROOFING O
//�, __ „
��//"
/ %fJ//�/
/
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REMARKS:
VENTILATION
FIRE ZONE ROOFING
FIREPLACE
SPARK ARRESTOR
GAR. FIREWALL
LATHING (g y �Q
MESH
INSULATION/SOUND
FINISH GRADING
FINAL INSPECTION
CERT. OCC.
FENCE FINAL
INSPECTOR'S SIGNATURESIINITIALS
'
GARDEN WALL FINAL
Desert Sands Unified School District
CERTIFICATION OF PAYMENT
OF
SCHOOL FACI-LJTY, rs f(�U
Olt,
TONJC tyCofi;•La u ta�yLa�C'�T ®` DATE: If 1g]o
Departmentl3h 8 munity Development
78-105 Calle Estado
La Quinta, CA 92253
This is to c rtify at -
developer of , which is
located at - -1 within
this District, has paid school faci ity fees imposed pursuant to the
auggho'r1i a rat d b Gove n lent Code S tion 5 080 in the a ount• of 1 /
$
`iNy 9 ,� ( y 1 �`�
covering a total •f sy re feet of ( ) residential or
( ) industrial/commercial deve opment and that building permits for
this footage in this development may now be issued by your jurisdiction.
601 z�� ILu-,M - f-3xA /Y\ oft
for ESERT SANDS NIFIED SCHOOL DISTRICT
White - Building Department • Yellow - Facilities Planning • Pink - Accounting • Gold - Developer
(10)-37
- a;i:
� J
AND WHEN RECORDED MAIL TO. ~ cc y
r c�
Z
Ni �: Mari1 yn .Kaiser — +i N Q>
�.
Address 103,_6 Via Palo Alto o
'. 0""(i U
C ly R Aptos, _.CA '95003.
SUiI«
ILLJ
MAIL TAX STATEMENTS TO
Nalne
Slices .
W
-Adtfi :::• SAM13 AS ABOVE.
City & - -
State L
SPACE ABOVE THIS .LINE'FOR RECORDER'S USE
CAT. NO. NN00578.
Corporation Cant Dbed
TO 1921 CA (6--86) THIS FORM FURNISHED :BY TICORTITLE INSURERS
The undersigned grantor(s) declares)
Documentary,tran§fer tax•is.$ 38=50'
J z (xi) computed on•full'value of property conveyed, or
a a ( ) computed on full value less value.of liens and encumbrances. remalning.at time of sale.
( `. Un.incorporatedfarea: (xx ).Clty;of La 'o inta
- and:
FOR VALUABLE CONSIDERATION, receipt of•whlch is hereby acknowledged,
4
F B &.A, INC..
a corporation organized. under the:laws of the State of, California hereby GRANTS
to-
-i
o .
MARILYN KAISER, An Unmarried''Woman
the. following described real property in the City., of La Quanta_
County of Riverside ,State"of California;
' Lot 11 and 12, Block 44, Santa Carmelita_ a't'.Vale La Qui�nta, Unit No. 4 as per
map recorded.in Book 15, Page 62 Of Maps, in the'.:office of. the County Recorder
.."of said County
j
In Witness' Whereof, said Corporation has caused Its corporate ,name and seal :to be affixed heretq„�d:t,, is
instrument to'be executed by;its r. Presldent•and, Secretg�y
thereunto duly authorized ;�� :.•�p�
F B '& A:INC
Dated August 7, '1989:
STATE OF CALIF O IA `.` `SS ; O lesiderl'�
COUNTY OF ''��.►�� (1 '' y ;;
On' C- GL-2� .7 �1d before me, the,,Secretary
undersign ed, r No ry Public in a d. fo�aid tate, personally.
appeared��� /i�
Nefser�alLKJinown_La lie or proved to me on the basis of sans
factory evidence to be the person who executed the within,;`
instrument as the President and
personally -known to OFFICIAL SEAL
me or proved to me on the bads of. J. McCLUOU01
satisfactory evidence to be
NOTARY
NOTARY PUDLIC- CALIFORNIA
the person who executed the within instrument as.:the, RIVERSIDE COUNTY
Secretary of ..;the Corporation that executed := ny:Cg41ISSIDN:EXP. DEC. 9. 199.11
the within instrument and ,acknowledged. to me ;that such
corporation executed the within instrument pursuant to -`its
by-laws or a resolution of its board -,of directors
WITNESS. nd and official seal.--.
e` (This area for official notarial seal)
Signatur
Title Order" No. Escrow or Loan No�- Rs
h.
MAIL'TAX STATEMENTS AS DIRECTED ABOVE
. .. tit f •
,/aP
;tr�ki':'T .. iQ•:.+►+•fi'f •v.r w,-•�yw�..-„y..Ki'�,wMr'Cs°i��~�^+'4^m.'.T ,.�y,.�'�-�v .rr .-�csr .-y-.,,wen'v„m�..waw-r••w,.•-iretrwwx;;��..:'-Mr+•+r+R+o':-+. y+aevv+l\`�•�rt�vh'r,"'�,..
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000
00291
0 29 e(5�1
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COUNTY OF RIVERSIDE ENVIRONMENTAL Ase"OM Pamm No.
3 — 052-- 0
HEALTH SERVICES DIVISION
PE„F,��IA )ADPL- C%T ,O FOR A SUBSURFACE SEWAGE DISPOSAL SYSTEM
Appi nt: Subilhit�pis, four
orm with copies of a scaled plot plan (1-20 scale) drawn to County speculations as indicated on the attached check Ilk
A non-refundable filing fee (see below) is required when the application is submitted. Check must be made payable to the County of
CMIRiverside. Approval of this application shall remain valid for a period not'to exceed one year from date of approval.
T2
VERIFY ITEMS IN`�(�ySorE��CT j?iN A FROM BUILDING & SAFETY APPLICATION BUILDING DEPARTMENT APPLICATION LOG #
Agent °
6 S�Li Ja
^T
Address &Firm 1n C 1; - 5t5,? -5 rb,+-Al
�J/�� �C�/j
Owner
Pho�n_e",� �
�/1 rrv_
Mail Address
1V �&
City
�i aviN
State A
Zip I
2Z�
Job Property Address
k6, P)LK,L14i
Legal Descri ,on Prop. (PM, Tract, Lot)
44,4
11+IZ
1 7,4 97 l/
Lot Size
�2 Ll 01
Water Agency/Well
0 VA/ pG
Use of Permit P/P, CU, etc.
Other
5-I-2-L4o
elling, Site Prep, etc.
ure of Applicant c
Date
CATEGORY: REV CODE FEE
CATEGORY: REV CODE FEE
SUBSURFACE DISPOSAL 1238 $ 57.00
❑ SITE EVALUATION UPON REQUEST 7349 $ 43.00 ,
❑ MULTIPLE PARCELS WITHIN SAME
(NO PLOT PLAN)
LAND DIVISION i
'❑ SEWER/SEPTIC VERIFICATION- 7348 $ 17.00
a. 1 at 4 Parcels (Each) 1238 $ 57.00
(Less than 1 year)
b. Each Parcel after 4 7344 $ 24.00
❑ PRELIMINARY ELECTIVE 7352 $ 23.00
❑ Rereview (2nd review same parcel) 7344 $ 24.00
EVALUATION (Attach DOH SAN 53)
❑. Site Evaluation in Conjunction with
❑ HOLDING TANK 7351 $ 47.00,x''
Critical Area 7348 $111.00
❑ ALTERNATIVEIEXPERIMENTAL 7345 $222.00
❑ Site Evaluation Lot Less than
SYSTEM
10,000 Sq. Ft. 7347 $ 87.00
INITIAL DATE
Holding Tank Agreements Completed ❑ Yes No
Certification of Existing S.D. System Required ❑ Yes No
WQCB Clearance required. (Attach Form ❑ Yes No
DOH SAN 007, Santa Ana Region Only)
Soils Pwcokdlon Report Required. ❑ Yes No
Special Feasibility Boring Report Required. ❑ Yes E No
Detailed Contour Plot Plans Required (1 to 5 ft. interval) ❑ Yes I No
Other ❑ Yes I No
Staff Specialist Lot Inspection Required ❑ Yes No
' Lot Inspection Date
Solis boring report by f i� ProjectDate
•�t -T-
. i . Dom.
Soils Map Page Sol Type Approved by f-
No. of System
Type of System(s)
❑ Folding Tank ❑ Existing
No. Dwelling Unite
Bedrooms, Fixture
(1) Septic Tank
Soil Rate
L
Graeae/Send
(
New ❑ Replacement
Units /�
''j
�✓y„
t /,�/
�4
f
Grease r'�
J ��r�2 //IAy%
r G.
(2) Leach Line Sq. Ft
II aowanee-^ 1�
Install Line(s) ft long it wide with
Leach Bed egJ6—
Bottom trench area
�.�-�^” ft rock/ . _ sq. ft
min. inches rock below dreinlines or`mom
arae
per running It
❑ NA
L'.eachlines/bed special design for slope:
(3) Pit Diameter
No. Pita
Pit Below
Seepage Ph Total Depth
Other.
Applicable
❑ 5 � 6
Inlet (BI)
�/
(TD) ? /
Allowable Dth
ep
N/A --,k—Max.
Overburden factor
� �j
n .')
2
No. 2 System
REMARKS: /
Or, y rt
A-11 heli ( st, sho P71c15f bye % iP'n �v A A01011P 0 k AV P
This application is AP4PROVED/D NIED for the category checked in SECTION B above, regarding the design of a subsurface disposal system as indicated
on the accompan lot rl! using the requirements set forth in SECTION C above. A building permit is necessary for the installation of the
above -designed system. No construction ispejmtt�e�l in the required reserved. 100% expansion area.
6+ u'
(1) Septic tank and sewer lines must be-Wminimum from any wells
Leach lines must be 100' minimum from any wells, including expansion area
E12-1
3)) Seepage pits must be 150' mini um from, an wells, incl dixpa sion area
Z—\-
Signature of Health Official Date
S
RECEIPT NO. ' ��+
�/
1 v
Issued By �.
, r
v� Date S 190
DISTRICT: ❑ Riverside,
❑ Indio
❑ Hemet q Perris ❑ Ranch
Calif. ❑ Blythe
DOH-SAN-122'(Rev. 7/89) DISTRIBUTION:
WHITE - Office file YELLOW - Applicant
PINK - Bldg. Dept GOLDENROD - Plans/Records